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Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism
Mitsuhide Naruse,Akiyo Tanabe,Koichi Yamamoto,Hiromi Rakugi,Mitsuhiro Kometani,Takashi Yoneda,Hiroki Kobayashi,Masanori Abe,Youichi Ohno,Nobuya Inagaki,Shoichiro Izawa,Masakatsu Sone 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.5
Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosteroneexcess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVSto patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasiveimaging and biochemical markers will drive a paradigm shift in the clinical practice of PA.
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Yano Yuichiro,Kanegae Hiroshi,Node Koichi,Mizuno Atsushi,Nishiyama Akira,Rakugi Hiromi,Itoh Hiroshi,Kitaoka Kaori,Kashihara Naoki,Ikeno Fumiaki,Tsuji Ichiro,Okada Kunio 한국역학회 2022 Epidemiology and Health Vol.44 No.-
OBJECTIVES: Using a dataset from a survey on national health and productivity management, we identified health and productivity factors associated with organizational profitability. METHODS: The Ministry of Economy, Trade and Industry conducted an annual survey on Health and Productivity Management between 2014 and 2021. We assessed the associations of organizational health and productivity management using survey questions collected in 2017 and 2018, and the rate of change in profits from 2017 and 2018 to 2020. We identified factors associated with organizational profitability using eXtreme Gradient Boosting, and calculated SHapley Additive exPlanation (SHAP) values for each factor. RESULTS: Among 1,593 companies (n= 4,359,834 employees), the mean age for employees at baseline was 40.3 years and the proportion of women was 25.8%. The confusion matrix for evaluating model performance had accuracy of 0.997, precision of 0.993, recall of 0.997; and area under the precision-recall curve of 0.999. The most important factors related to an increase in corporate profits were the percentage of current smokers (SHAP value 0.121), per-employee cost for health services (0.084) and medical services (0.050); the percentage of full-time employees working in sales departments (0.074), distribution or customer service departments (0.054); the percentage of employees who sleep well (0.055); and the percentage of employees who have a habit of regular exercise within a company (0.043). CONCLUSIONS: The lifestyle health risk factors of employees and organizations’ management systems were associated with organizational profitability. Lifestyle medicine professionals may demonstrate a significant return on investment by creating a healthier and more productive workforce.
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